Community Based Newborn CareBRAC

PARTNERSHIP APPROACH TO ACHIEVE THE MDGS IN BANGLADESH

PRESENTATION OUTLINE

Maternal and Child Health Scenario in Bangladesh

BRAC MNCH Programme

Service Delivery

Service provider

Intervention areas

ANC, PNC

Essential Newborn Care

Reduction of NMR

Challenges addressed, Lessons learned

Maternal and Child Health Scenario in Bangladesh

An increase in hospital birth from 9.2% to 23% and skilled attendance at delivery from 12.2% to 26.5% in three years

Of 250,000 annual under-five deaths, over half die in their first month

At least two-thirds of these deaths could be averted by ensuring appropriate care

A reduction from 12,000 maternal deaths per year in 2001 to about 7,300 in 2010

Source : BMMS 2010, BDHS 2007

www.brac.net

Rural MNCH

Improving Maternal, Neonatal and Child Survival

BRAC-GoB-Unicef

DFID, AusAID, EKN and BRAC

BRAC MNCH PROGRAMME

www.brac.net

19 million rural populations

BRAC MNCH PROGRAMME IMPLEMENTATION AREAS

1. Capacity development of HR

2. Community empowerment

5. Linkage between community and public/private health facilities

4. Timely Referral of emergency cases

NHW

SK

Staff

SS

CSBAMidwife

p

OPERATIONAL STRATEGIES

3. Services rendered at community, households and facilities

SERVICE PROVIDER AT COMMUNITY LEVEL

Selected from localities Age 25-45 years Married Willingness to work Community acceptability

Selected from localities Age 25-45 years Married Willingness to work Community acceptability

Selected from localities Age 20-35 years Married Minimum SSC Willingness to work Community acceptability

Newborn Health Worker

Shasthya Shebika

Shasthya Kormi

SERVICE DELIVERY

Maternal Care Identification of pregnancy Ante, intra & post natal care Referral of maternal complications Family planning Post-abortion care

Essential Newborn care Special care for LBW babies Management of birth asphyxia Detection and referral of Neonatal sepsis Referral of complications

Exclusive breast feeding and complementary feeding Immunization and Vitamin A intake Community case management of ARI and diarrhea Referral of complications

Neonatal Care

Child Care

REFERRAL SYSTEM

Referral Hub

www.brac.net

UTILIZATION OF ANTENATAL AND POSTNATAL CARE

BDHS 2007 2009 2010 2011 (Jan-Sep)0

20

40

60

80

100

15

8388

93

4 or more ANC

Perc

enta

ge

Baseline 2009 2010 2011 (Jan-Sep)0

20

40

60

80

100

28

80 84 86

3 or more PNC

Perc

enta

ge

Baseline

www.brac.net

A major shift is observed in place of birth from home to Hospitals

TREND IN PLACE OF BIRTH

Baseline 2009 2010 2011 (Jan-Sep)50

60

70

80

90

100

8678 75 70

1422 25 30

Trend in place of birth

Home Hospital

ESSENTIAL NEWBORN CARE

Increasing coverage of essential newborn care

BDH

S 20

07

2009

2010

2011

(Jan

-Sep

)

BDH

S 20

07

2009

2010

2011

(Jan

-Sep

)

BDH

S 20

07

2009

2010

2011

(Jan

-Sep

)

Trained attandance at home delivery

Thermal care within 10 minutes

Initiation of breast feeding within 1 hour

of birth

0

25

50

75

100

11

66 6876

26

8491 94

0

8793 95

Pe

rce

nta

ge

43

LOW BIRTH WEIGHT DETECTION AND SPECIAL CARE

2010 2011 (Jan-Sep)Rangpur,

Gaibandha, Mymensingh

0

20

40

60

80

100

84 85

19 2115

19

Low birth weight detection and special care

Birth weight taken Low birth weight Spacial care

Sick Newborn Case Management

2009 2010 2011 (Jan-Sep)0

0.5

1

1.5

2

2.5

Neonatal sepsis diagnosed and referred

Diagnosed Referred

2009 2010 2011 (Jan-Sep)0

0.5

1

1.5

2

2.5

3

3.5

4

Birth asphyxia diagnosed and managed

Diagnosed Managed by SS

* BDHS 2007; BRAC MIS

REDUCTION OF NEONATAL MORTALITY

The NMR reduction

is 29% over four

years

19931997

20012004

20072008

20092010

2011 (Jan-S...

MDG ta

rget

0

10

20

30

40

50

60

52

48

42 41

37

2231 30

2826

22

National Statistics Intervention Areas

Per

1,00

0 Li

ve B

irth

s

CHALLENGES ADDRESSED

Changes in behavior and practices

Community health worker’s adoption of new knowledge and practices

Lack of competence among health providers to manage neonatal sepsis

Lack of services in referral facilities for managing newborn complications

LESSONS LEARNED

Community health workers can perform if properly trained and supervised

Support of skill mix team

Performance based incentives

Community support network

Postnatal home visit

Referral support network

THE END

THANK YOU